Urban Governorates Research Articles

Pattern of Virtual Consultations in the Kingdom of Saudi Arabia: An Epidemiological Nationwide Study

BackgroundIn the Kingdom of Saudi Arabia (KSA), little is known about the adoption of virtual consultations (VCs), with most studies being survey-based leading to varying results. This study aims to utilise secondary collected data on the use of both kinds of VCs currently available, and to epidemiologically describe the adoption of these consultations.MethodsThis retrospective study analysed data provided by the Ministry of Health between January 1st 2021 and June 30th 2022. For both the home-based and the hospital-based consultations, variables included the age and sex of patients, date of consultation, duration in minutes, closure status for the appointment and the governorate in which the patient is residing. A heat map was drawn to present patterns of utilisation across the country.ResultsThe total number of VCs for both types were 1,008,228. For both types, females were higher adopters (54.73%). Of the total number of consultations, 751,156 were hospital-based. Of these consultations, family medicine consultations were the most common (20.42%), followed by internal medicine. Maternity follow-up clinics were higher in home-based clinics. The proportion of patient no-shows was high overall (48.30%). Utilisation was high in urban governorates, and low in rural ones.ConclusionFindings have several implications on health policy. It provides further evidence of the importance of family medicine, where it was the most common speciality even in hospital-based settings. The high variability in the adoption of consultations across rural and urban areas as well as the extremely high number of patient-no-shows warrants further investigation.

The impact of management practices on export margins of firms: evidence from a recent Egyptian industrial survey

PurposeThe paper aims at studying the effect of management practices on the extensive and intensive export margins of Egyptian manufacturing firms.Design/methodology/approachThe study relies on the 2020/2021 Egyptian Industrial Firm Behavior Survey (EIFBS) which comprises 2,383 manufacturing firms representing small, medium, and large sized firms located in different regions of Egypt: Urban Governorates, Lower Egypt, and Upper Egypt. It constructs an overall management z score for each firm to estimate its effect on a firm’s probability of exporting and value of exports using Ordinary Least Squares (OLS) regressions.FindingsResults indicate that good management is associated with a higher probability of firm exporting as well as higher export revenues conditional on exporting, robust to controlling for the level of domestic sales. These effects do not differ by firm ownership or type of sector, but rather by firm size, with managerial competence raising the probability of exporting more for large-sized firms. Additionally, good management is associated with higher firm productivity, innovation and worker training propensities which gives evidence that it is both an efficiency and a quality enhancer. Moreover, monitoring and targeting practices have significant positive effects on both margins, while incentives are only significant for the extensive margin.Practical implicationsFirms that aim at enhancing their export prospects and revenues should devote resources to review and upgrade their management systems to boost their product quality and production efficiency. Policy-wise, the government should create a competitive market environment that is open to both domestic and foreign firms’ entry to stimulate the adoption of better management practices.Originality/valueThe paper is the first to explore the link between firm management practices and export outcomes for a MENA country (Egypt). It makes use of a recent survey, the 2020/2021 Egyptian Industrial Firm Behavior Survey (EIFBS). The findings shed light on the importance of different management components (monitoring, targeting and incentives) in driving a manufacturing firm’s export performance.

Examining the Most Important Factors Affecting the Egyptian Family’s Choice of the Ideal Number of Children in the Light of the 2015 Demographic and Health Survey

Examining the Most Important Factors Affecting the Egyptian Family’s Choice of the Ideal Number of Children in the Light of the 2015 Demographic and Health Survey

Adapting an integrated acute respiratory infections sentinel surveillance to the COVID-19 pandemic requirements, Egypt, 2020–2022

ObjectivesIn Egypt, an integrated surveillance for acute respiratory infections (ARIs) was established in 2016 to identify the causes of ARIs. The surveillance system includes 19 governmental hospitals. In response to the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organisation (WHO) requested surveillance adaptation to address the emerging challenges. This study aims to describe the experience in Egypt of adapting ARI surveillance to the COVID-19 pandemic. MethodsWHO case definitions were used to identify patients with ARIs. Nasopharyngeal/oropharyngeal swabs were collected for SARS-CoV-2 and influenza testing. Demographic and clinical information were obtained by interviewing patients at the hospitals. During the COVID-19 pandemic, the first two outpatients daily and every fifth admitted patient were enrolled in the study. To determine the status of ARIs in Egypt during the pandemic, patient demographic, clinical and laboratory data from 2020 to 2022 were obtained and descriptive analyses were performed. ResultsOverall, 18,160 patients were enrolled in the study, including 7923 (43.6%) seen at outpatient clinics and 10,237 (56.4%) inpatients. Of the study participants, 6453 (35.5%) tested positive for ARIs, including 5620 (87.1%) for SARS-CoV-2, 781 (12.1%) for influenza and 52 (0.8%) for SARS-CoV-2/influenza coinfection. SARS-CoV-2 was the cause for 95.3% of admitted patients and 65.4% of outpatients. Influenza subtypes included A/H3 (55.7%), Influenza-B (29.1%) and H1/pdm09 (14.2%). Compared with influenza, SARS-CoV-2 tended to infect the elderly, in warm weather and in urban governorates, and resulted in more hospitalisations, longer hospital stays and higher case fatalities (16.3% vs 6.6%, p < 0.001). ConclusionsARI surveillance in Egypt was successfully adapted to the COVID-19 pandemic and effectively described the clinical characteristics and severity of circulating viruses. Surveillance reported the re-emergence of influenza with a severe course and high fatality. Surveillance is essential for monitoring the activity of respiratory viruses with the aim of guiding clinical management, including preventative and control measures.

Prosthetic rehabilitation modalities and their socioeconomic association in a sample of adult Egyptians

Background Teeth loss results in significant complications that can severally affect the individuals’ general health and social activities. Several studies have documented the association between socioeconomic issues and the prevalence of oral diseases and prosthetic rehabilitation. Thus, this study aimed to explore the impact of socioeconomic factors on prosthetic rehabilitation modalities in a sample of adult urban and rural Egyptian populations. Patients and methods A total of 400 adults of age over 18 years were included in this study. Half of them were from urban governorates (Cairo and Giza). And the other half were from the rural governorate (Al-Fayoum). Information concerning demographic (sex and age) and socioeconomic (education level, occupation, and income) factors were collected using the modified WHO questionnaire. In addition, prosthetic rehabilitation status was evaluated through intraoral examination. Results The percentage of female participants was higher than males in both urban and rural regions. The age range for more than two-thirds of the participants was from 30 to 60 years. In urban areas, about 39% of participants were completely dentulous, 34.5% were partially edentulous without prosthetic rehabilitation, and only 26.5% made dental prostheses. Regarding rural participants, about 35% of them were completely dentulous, 64.5% partially edentulous without prosthetic treatment, and only 0.05% received prosthesis. Comparison between the urban and rural dentition status and rehabilitation modalities showed a statistically significant difference (P&lt;0.05). Socioeconomic factors (education, occupation, and income) affect the type of prosthetic treatment modalities, particularly fixed prostheses especially in the urban area. Conclusion Socioeconomic determinants greatly affected prosthetic rehabilitation modalities in the studied urban and rural Egyptians. In rural areas, socioeconomic factors negatively impacted the capability of prosthetic treatment.

Egypt Family Planning Method Mix Indicates Shifting toward Hormonal Contraceptives

BACKGROUND: The study is of practical importance for policy makers and family planning (FP) program managers as the profile of FP method-mix with a shift from a mechanical method as intrauterine devices (IUD) to hormonal methods such as oral contraceptives (OCs) and injectables predicts a critical situation for maternal and child health and reflects shortcomings in FP service delivery program. AIM: The purpose of the current study was to identify reasons for the progressive shift from IUD to OCs in Egypt. METHODS: The study is an-operations research conducted at four levels of the Ministry of Health and Population/FP (MOHP/FP) service delivery: Central (headquarter, HQ), governorate, district, and service delivery points. It included five of MOHP/United Nations Fund for Population Activities-Contraceptive Security Project governorates that represent, urban governorates, Lower Egypt, and Upper Egypt. Both qualitative data in-depth interviews with MOHP/HQ staff, Two Focus Group Discussions with FP Health Directorates staff and nurses in the five governorates, and quantitative data through a self-administered questionnaire for 607 service providers (SP). RESULTS: There was a consensus on the actual shift from IUD to OCs use. Reasons were the absence of incentives for healthcare providers for IUD insertion services (64%) and improper training of physicians (45%), and the availability of OCs all time. CONCLUSION: The three articulating issues that lead to shifting from IUD to OCs are: Unsatisfactory training and incentive systems for SPs and the clients’ choice of OCs for independent use/autonomy, and availability of OCs all the times at a reasonable cost in both the public and private sectors.

Regional disparities in prevalence of obesity among school-aged children in Egypt: A country case study from The Eastern Mediterranean Region

Background: This study is a review of recent research conducted in Egypt on the problem of rising prevalence rates of obesity among school-aged children. Methods: The search was conducted in three phases. The key words used were obesity, overweight, school-aged children, and nutritional status specifically for Egyptians over the past decade (2010–2021). Online research sites and the libraries of the Egyptian universities of the eluc.org. websites were searched along with on-site visits to the libraries of thesis universities and other research institutes in Egypt, to obtain full research material. Finally, retrieved data were analyzed statistically. Results: The search identified 24 studies that covered 15 governorates and one national survey that covered 25 governorates. The prevalence of obesity in the pooled populations was 10.6%. Prevalence rates of obesity were highest in Lower Egypt (LE) (10.0%) and urban governorates (9.2%) compared to Upper Egypt (UE) governorates (6.3%, p&gt;0.05). Obesity in the children over 10 years was slightly higher among females in the urban (5.1%) and LE governorates (5.2%) compared to males (4.1 and 4.8%, respectively). However, it appeared higher in males (5.2%) compared to females (3.2%) in UE governorates (p&gt;0.05). Conclusion: Obesity in Egypt is rising and is related primarily to high consumption of unhealthy foods. Member states must take active steps to regulate marketing of unhealthy foods to children.

Epidemiology and outcome of influenza-associated infections among hospitalized patients with acute respiratory infections, Egypt national surveillance system, 2016-2019.

IntroductionEgypt has established different types of surveillance systems to monitor influenza activities, early detect outbreaks, and tailor efficient prevention and control strategies. This is the first study to describe epidemiology and outcome of influenza‐associated infections among hospitalized patients using the National Electronic Disease Surveillance System (NEDSS) data, 2016‐2019.MethodsData reported from 284 hospitals all over Egypt were extracted from the NEDSS. Data of hospitalized patients with Acute Respiratory Infections (ARI), 2016‐2019, were included in the analysis. Laboratory testing for influenza by RT‐PCR according to US CDC testing protocol was used to confirm influenza type and subtype.ResultsOverall 46 417 patients hospitalized with ARI were identified, their mean age was 30.9 ± 26 and 52.9% were males. Among 41 512 (89.4%) laboratory‐tested patients, 7167 (17.3%) were positive for one or more types of influenza viruses. Influenza viruses circulated in all ages and throughout the year, with higher rates in winter, late childhood, and middle ages. Mortality from influenza was significantly higher than other causes of ARIs (5.0% vs 3.8%, P < .001), and it was associated with older ages, December‐May, delay in hospital admission, residence in urban and frontier governorates and infection with A/H1N1 virus. The distribution of influenza subtype by time shows alternate pattern between A/H1N1 and H3N2, each subtype peaks every other year with a high peak of A/H1N1 in 2016.ConclusionsThe national Egyptian surveillance succeeded to describe the epidemiology of hospitalized patients with ARIs and influenza in Egypt over time. Surveillance with strain‐specific laboratory testing and annual assessment of associated severity might be useful to guide influenza prevention and control strategies including vaccination and case management.

Determinants of severe physical disciplinary practices against children in Egypt

BackgroundAlthough nearly 43 % of Egyptian children aged less than 14 years had ever experienced severe physical violent punishment at home, no previous studies identified the predictors of the practice in Egypt. ObjectiveThis research aims at identifying the determinants of the use of any severe violent physical practice to discipline children. Participants and settingThe latest national Egyptian Demographic and Health Survey is the main source of data. The caregivers of 13024 children were interviewed. MethodsA binary logistic regression model is developed to identify the determinants of the use of severe physical disciplinary practices. ResultsResults show that children whose parents believe that physical punishment is necessary to discipline children are more likely to experience severe violence (OR = 3.3). Children in the preprimary stage have a high odds ratio of experiencing a severe violent punishment compared to those in preparatory and secondary stages (OR = 3.5). Children whose mothers have experienced domestic physical violence are more likely to be subject to severe physical violence (OR = 1.6 for husband violence, and 1.4 for parents/siblings violence). Children living in Urban Lower Egypt are approximately twice likely as children living in urban governorates to be subject to severe physical violence. Children living in the poorest households are the most likely to experience severe physical violence. ConclusionSevere violent disciplinary practice inside the home is common in Egypt. The findings urge for activating Egyptian Child Law and implementing continuous training programs for parents on positive parenting.

Patients' Satisfaction with Primary Health Care in Egypt: Exploring the Gap between Rural and Urban Governorates

Patient satisfaction has been frequently used as an indication of the overall quality of health care providers. Understanding patients` needs and expectations is crucial to PHC providers to improve patients` health. This study aims to explore patients' satisfaction with primary health care services in urban and rural areas in Egypt. The study shows a gap in patient`s satisfaction across Alexandria and Sohag governorates. This implies a difference in reform implementation across urban and rural governorates. More attention should be given to different dimensions of health care provision at PHC level in rural governorates including clinical and nonclinical training of nurses, improvement in amenities and other facilities, improvement of registration system, and promoting the new system.

Findings from a needs assessment of public sector emergency obstetric and neonatal care in four governorates in Yemen: a human resources crisis

Recent reviews suggest that it is unlikely Yemen will reach Millennium Development Goal 5 on maternal health by 2015. We conducted a needs assessment in 2010 to identify the human resources constraints in delivery of emergency obstetric and neonatal care (EmONC), in one urban and three under-served rural governorates. The assessment tools were adapted from the UN Guidelines for Monitoring Availability and Use of EmONC. Findings showed that while the urban governorate (total population 666,210 with 26,648 expectant mothers yearly) had 54 obstetricians, 10 anaesthetists and 72 paediatricians, the three rural governorates (total population 1,885,371 with 75,414 expectant mothers yearly) together had only three obstetricians, three anaesthetists, and eight paediatricians. Furthermore, in the rural governorates, with an 0.5% caesarean section rate, which is far below the 5% minimum for this UN indicator, no district hospital had an operating surgeon or an anaesthetist. There was also a marked scarcity of female general physicians and a large disparity in the proportion of births with a skilled attendant between the rural (12%) and urban (34%) governorates. Findings emphasize the need for increasing the coverage of EmONC nationally, but especially in rural areas, through more equitable staff distribution and promotion of task shifting. Developing a national human resources plan and ensuring an enabling policy are prerequisites.

Hepatitis gender gap in Egypt: A study in medical geography

This study has confirmed the fact that there is a gap between males and females of hepatitis in Egypt. This gap in the numbers of infected people and percentage in all 6 types of hepatitis A, B, C, D, E, F where the percentage of infected males is higher than females, in the available selected years study 2002, 2003 and 2005. This gap is not limited to the population of one governorate which is inferior to one another; but this gap is wide between males and females in all governorates equally. This study has confirmed that this gap includes age specific ratio too, the percentage of morbid males in all age categories is higher than females, but this gap is much wider in median age stage than other categories. There are differences between rural and urban places in the percentage of disease infection between males and females, where the morbidity in rural is prejudice urban places, and the high percentage in some urban governorates and Capital does not mean that these cities are blighted or deteriorated, but because most cases in Egyptian governorates prefer to go to them for treatment. This study has confirmed that the life Expectancy in females is higher than males at least 4 years and this due to males exposure to risk of occupational diseases related to agricultural activity, and endemic diseases which cause high mortality rates in males compared with females

Fast Food Intake by Kuwaities

High prevalence of obesity in Kuwaities has been attributed to increased intakes of Western fast‐ foods. Data from 6287 adults in the Kuwait National Nutrition Surveillance 2006‐2007 indicate higher intakes of fried potatoes (FP), a proxy for Western fast‐food intake, by young, urban governorates, better educated, and non‐smoking groups. Multiple regression analysis indicated that age and education were independent variables (Adjusted R2 = .095). FP intake was correlated with intake of fruit juice and total vegetables but negatively associated with whole fruit, raw vegetable and carrot intakes. The recognition of these assocaitions should enable better targeting of nutrition and health education programs for the nation.

EVALUATING EMPLOYMENT POLICY PROGRAMS TO ALLEVIATE THE UNEMPLOYMENT: CASE STUDY OF EGYPT (In Arabic)

EVALUATING EMPLOYMENT POLICY PROGRAMS TO ALLEVIATE THE UNEMPLOYMENT: CASE STUDY OF EGYPT (In Arabic)

Field investigations of brucellosis in cattle and small ruminants in Syria, 1990-1996

The authors present the epidemiological status of brucellosis in cattle and small ruminants in Syria from 1990 to 1996, based on laboratory findings at the Brucellosis Centre, Damascus. Initial investigations using the Rose Bengal plate test, the complement fixation test and a miniaturised variant of the slow agglutination test were conducted throughout the country in 1990 and 1991, revealing an overall herd seroprevalence rate of 3.14% in cattle herds and 2.94% in small ruminant flocks. Although partially biased by previous vaccination of young female cattle with S19 vaccine, these figures indicate that brucellosis in cattle is widespread, particularly in the urban governorates (provinces) of Damascus, Aleppo and Suwaydah. Brucellosis seroprevalence in sheep and goats was relatively high in the governorates of Damascus, Aleppo and Dara'a. The results of a second series of investigations, performed between 1992 and 1996, show that herd seroprevalence in cattle decreased steadily from 17.48% in 1992, to 2.59% in 1996, in the Government-owned farms, while seroprevalence increased in the private sector during the same period. The difference may be explained by the restriction of brucellosis vaccination to public farms (although this was far from systematic), combined with partial application of a 'test-and-slaughter' policy. In sheep and goats, brucellosis seroprevalence fluctuated in the two sectors, but was higher in the private sector where husbandry is principally extensive. Bacteriological investigations led to the isolation of Brucella melitensis biovars 2 and 3 in sheep and B. abortus biovar 9 in cattle. Although no specific methodology was employed, particularly with regard to sampling, this study is significant as the first international report of the distribution of brucellosis in Syria. Further, well-structured studies are required, the results of which could be used to plan an appropriate national control programme for brucellosis.

The decline of female circumcision in Egypt: evidence and interpretation

Female circumcision is widespread in Egypt. Research suggests that the practice persists because of a belief that circumcision will moderate female sexuality, that it will assure a girl's marriagability, and that it is sanctioned by Islam. Using data from a nationally representative survey of adolescents, this paper investigates the prevalence and social correlates of circumcision among girls aged 10–19, the circumstances surrounding the procedure, and the attitudes of adolescents towards it. While the vast majority of adolescents are circumcised, a life table analysis indicates that girls today are at least 10 percentage points less likely to undergo female circumcision than were their mothers. Circumcision may have begun to decline prior to the time when the current cohort of girls were at risk; however, the data hint at a temporal association between the decline and the 1994 International Conference on Population and Development (ICPD) in Cairo, a time when the campaign against circumcision gained momentum. Over half of circumcised girls reported that the procedure was performed by a physician or nurse rather than a traditional practitioner. This represents a substantial increase over rates of “medicalized” circumcision found among earlier cohorts of Egyptian women. Even among circumcised girls, support for the practice is by no means universal, with 14 percent saying they think the procedure is unnecessary and a further 28 percent expressing ambivalence. A multivariate analysis indicates that girls who have been or are currently in school, who live in urban governorates, and who are older are more likely to believe that circumcision is not obligatory. When the analysis includes boys as well as uncircumcised girls, a large gender gap emerges, with boys considerably more supportive of the practice than are their female counterparts.

The prevalence of anemia among clients of family planning clinics in Egypt

A hospital-based study of the prevalence of anemia among clients of family planning clinics in Egypt was carried out in collaboration with a number of university hospitals. The study aimed to estimate the prevalence of anemia among the clients of family planning clinics and to determine the underlying risk factors for developing anemia in this population, with special emphasis on the role played by different contraceptive methods. The study was designed as a cross-sectional study and was carried out in seven family planning clinics of Alexandria, Mansoura, Cairo, Al-Azhar, Ein Shams, El Minia, and Assiut University Hospitals during August 1993 to March 1994. A total of 1039 clients of family planning services who fulfilled the selection criteria were recruited in the study. A standardized interview questionnaire was used to record pertinent information on study subjects. As well, laboratory investigations were made to determine the hemoglobin level and the presence of bilharzial infection. The prevalence of anemia in the studied population reached 49.6%, with variations among centers. Anemia was more prevalent among urban compared to rural residents (55.7% and 42.0%, respectively). Anemia was more common in Lower Egypt, followed by urban governorates and Upper Egypt. Other independent determinants associated with high prevalence of anemia included: young age (20–39 years), lack of obesity, heavy menstrual periods, low parity, use of the intruterine device (IUD), low intake of iron-rich foods, and bilharzial infection. Use of IUD were significantly associated with the highest prevalence of anemia among all contraceptive users (64.9%), and IUD users had the lowest level of hemoglobin compared to nonusers or users of other methods. Given the increasing prevalence of IUD use in Egypt, a major recommendation of this study would be to introduce the prescription of iron supplementation tablets as part of IUD services provided in family planning clinics, both to new users and to current users. Other recommendations include early treatment of menstrual disturbances and parasitic infections (including schistosomiasis), as well as improvement of the nutritional status of women at high risk for developing anemia, through mass media campaigns addressing dietary patterns and the health benefits of intake of iron-rich, inexpensive food items.

Hepatitis C antibody prevalence in blood donors in different governorates in Egypt

Markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were sought in serum samples from 2644 blood donors in 24 of Egypt's 26 governorates. Of the 2644 samples, 656 (24·8%) were shown to contain anti-HCV immunoglobulin G antibody by Abbott second generation enzyme immunoassays (EIA). Of 85 EIA-positive samples tested by recombinant immunoblot assay, 72 (85%) were positive. HCV seroprevalence in the governorates ranged from zero to 38%; 15 governorates (62%) had an HCV antibody prevalence greater than 20%, and 6 (25%) greater than 30%. Governorates with higher seroprevalences were located in the central and north-eastern Nile river delta, and south of Cairo in the Nile river valley. Subjects from areas in and adjoining the Sinai peninsula, in the eastern and western desert, and in southernmost Egypt, had the lowest prevalence of HCV antibody. The large urban governorates of Cairo and Alexandria had antibody prevalences of 19% and 11%, respectively. A total of 39·4% subjects had evidence of HBV infection (and-HBV core antigen total antibody). HCV infections were detected more frequently in donors with markers for HBV infections than in uninfected subjects (36% versus 18%, P < 0.001).

Lower Egyptian Fertility Linked to Later Marriage, Increased Method Use

This paper reports on several analyses of contraceptive use trends and fertility determinants in Egypt. Analysis is based primarily on data from the 1992 Egypt Demographic and Health Survey (EDHS). One study used data from the 1980 Egypt Fertility Survey the 1984 Egypt Contraceptive Prevalence Survey and the 1988 and 1992 EDHS. This study documents the doubling of contraceptive use among married women during 1982-90. The second study uses birth history from the 1992 EDHS in the analysis of fertility decline and its determinants. The first study indicates that contraceptive prevalence rose from 24% in 1980 to 47% in 1992. Slower prevalence rate increases occurred in high-prevalence regions of Lower Egypt and Urban Governorates. A rapid increase in prevalence rate occurred in rural areas of Upper Egypt. There was a shift in choice of methods. IUD use increased and use of oral contraceptives decreased slightly. Increases in use occurred in all age groups. Levels of use were lowest among adolescents and women in their early 20s. 32% of women with 1 child used contraception in 1992 compared to only 16% in 1980. 59% of women with 3 children used contraception in 1992 compared to only 29% in 1980. Method use was highest among the most educated women. Findings from a logistic model indicated that urban women were 1.5 times more likely to use contraception. Women living in Lower Egypt or Urban Governorates were twice as likely to use contraception as women in Upper Egypt. In the second study researchers found that delayed age at marriage changes in postpartum insusceptibility and an increase in the proportion of reproductive age women contributed to a 13% decline in fertility during 1988-92. Women born between 1963 and 1977 had much lower fertility than women born earlier. The number of women with a second birth within 5 years of the first declined between 1988-92. Both studies confirmed a fertility transition.